Click to edit Master title style Status of ICD-10 Challenges and Successes 2014 Infian User Group Meeting September 17-18, 2014 Presented by: Robin Heath

OBJECTIVES Identify the ICD-10 Implementation Date Identify why organizational preparation for ICD-10 is a must Identify the steps your organization should take to ensure a smooth transition to ICD- 10 List available ICD-10 training opportunities Describe facility challenges and successes

ICD-10 implementation/compliance date? O ctober 1, 2015 ICD-10 compliance means that a HIPAA- covered entity uses ICD-10 codes for health care services on or after October 1, 2015.

Dates of Services (DOS): Is it ICD-9 or ICD-10? For DOS prior to October 1, 2015 continue to use ICD-9 For DOS October 1, 2015 and after use ICD-10 Practice management systems must be able to accommodate both ICD-9 and ICD-10 until all transactions prior to October 1, 2015 have been processed and/or all insurers are on board with ICD-10 processing

Partial Code Freeze CMS has placed a partial freeze on code changes until one year after the ICD-10 implementation Only codes for new diagnosis and new technologies will be considered Last regular update to ICD-9-CM and ICD-10 was October 1, 2011 Regular ICD-10 updates begin again on October 1, 2016

Why should my organization prepare now for the ICD-10 transition?

ICD-10 will be one of the most significant challenges the healthcare industry will face in the next several years. Increasing the number of codes from approximately 24,000 ICD-9 codes to over 140,000 new ICD-10 codes. The transition will change how your organization does business and most organizations will need to devote staff time and financial resources for transition activities. The results of a recent CMS survey of 242 healthcare shows providers anticipate a minimum of 10% reimbursement loss due to improper and denied claims, with 60% of those surveyed anticipate cash flow issues to arise.

What steps should my organization take to ensure a smooth transition to ICD-10? Organizations must determine areas of risk and opportunity throughout the organization The goal of any assessment is to minimize the negative impact of ICD-10 implementation on the organization’s revenue cycle. With proper preparation, organizations can avoid losses and cash collection delays during ICD-10 implementation due to increased Accounts Receivable and improper and returned claims. Approaching the conversion from an organizational perspective, as opposed to solely from a health information management or information technology perspective, allows organizations to address the associated impact to facilities, physicians, operations, and patient satisfaction.

Why should my organization prepare now for the ICD-10 transition? Increased demand for High-Quality Documentation High-quality documentation provides a more accurate clinical picture of quality of care provided Better clinical documentation promotes better patient care – More accurate acuity, severity, and risk mortality management – Quality and performance reporting – Reimbursement – Severity-level profiles – Provider profiles – Present on admission reporting – Hospital-acquired conditions

Why should my organization prepare now for the ICD-10 transition? Clinical Documentation Challenges Ensuring high-quality documentation without excessive administrative burden or encroachment on time spent on patient care Ensuring sufficient documentation to support code assignment while continuing to document in clinical terms Need for good clinical documentation not greater volume

Why should my organization prepare now for the ICD-10 transition? Improvement in clinical documentation has immediate benefits

What steps should my organization take to ensure a smooth transition to ICD-10? Establish an operational milestone plan – Establish a organizational steering committee which includes Executive leadership Project management team Representatives from key departments – Revenue cycle – IT – Clinical care – Finance – Operations

What steps should my organization take to ensure a smooth transition to ICD-10?

– Pinpoint ICD-10 Operational Impacts Evaluate and update procedures and workflows for ICD- 10 touch points Establish KPI’s that will be used for ICD-10 production Review documentation templates, forms and outlines for deficiencies Review referrals, authorizations impacted by ICD-10 changes Plan for staff augmentation to address productivity challenges

What steps should my organization take to ensure a smooth transition to ICD-10? Conduct External vendor and payer testing – Simulate a standard testing environment – Establish vendor/payer testing deadlines – Test comparisons, ranking and trending – Test flows, processes and data with external vendors Payers Outsourced billing, coding or collection agencies Government reporting requirements based on diagnosis Quality and metric reporting related to meaningful use

What steps should my organization take to ensure a smooth transition to ICD-10? Consider Revenue Cycle Optimization – FOLLOW THE MONEY

What steps should my organization take to ensure a smooth transition to ICD-10? Understand that those frequently used codes and the ones that generate the most revenue provide a window into critical areas of focus. Establish current revenue cycle management performance baseline benchmarks for metric comparisons with ICD-10. Determine the financial impact of the transition to ICD-10

What steps should my organization take to ensure a smooth transition to ICD-10? Clinical Documentation Improvement Strategies Identify documentation improvement opportunities that could impact initiatives-this may not be only ICD- 10 coding Determine best solution to address each documentation gap – One size does not fit all! – Modification forms or templates – EHR documentation template – System Prompts – Education – Workflow or operational process changes Prioritize – start with “low hanging fruit” or issues with greatest impact

The System Impact of ICD-10

What types of ICD-10 training is available? The American Health Information Management Association (AHIMA) CMS EDI - Workgroup for Electronic Data Interchange HIMSS spx?ItemNumber= spx?ItemNumber=30568

What is Infian doing to prepare for the ICD-10 transition? Available with Version V72 – Service Pack 13 & 19 – Utility to Import ICD-10 Code files from CMS Includes new codes and updates to codes – Utility to Import ICD-9 to ICD-10 Mapping file from CMS – Tools to assist with mapping ICD-10 Codes to existing TIME ICD-9 codes. – ICD-10 Look-up – Reassign Diagnosis Codes – Unmapped Diagnosis Codes

What is Infian doing to prepare for the ICD-10 transition? CMS provides a file which includes a list all of the current ICD-10 codes. You will need to download this file to a location on a workstation that is also accessible from the TIME system Infian provides tools to import and merge these ICD-10 codes into TIME

What is Infian doing to prepare for the ICD-10 transition? CMS provides another file that maps ICD-9 codes to ICD-10 Codes You will need to download this file to a location on a workstation that is also accessible from the TIME system Infian provides a tool to import the file into TIME so that it can be used in the mapping process

What is Infian doing to prepare for the ICD-10 transition? Once the mapping file has been imported, you can use a utility in TIME to map instances where there are – 1 ICD-9 code linked to 1 ICD-10 code – 1 ICD-9 code linked to many ICD-10 codes – Many ICD-9 codes linked to 1 ICD-10 code

What is Infian doing to prepare for the ICD-10 transition? After all codes have been mapped using the files provided by CMS, you can use the TIME system to identify any Diagnosis Codes that have not been mapped to an ICD-10 code in TIME – Determine whether existing TIME codes are now obsolete and need to be logically deleted – Identify which Diagnosis codes may need to be reassigned to a new Diagnosis code and linked to an ICD-10 code TIME also provides a utility to identify patient records using old diagnosis codes and update them with new diagnosis codes which have been assigned ICD-10 codes

What is Infian doing to prepare for the ICD-10 transition? ICD-10 Roadmap The purpose of this document is to assist users with the process for downloading and importing ICD-10 codes into TIME. This document is comprised of 3 sections for each step. The first section, ‘Application & Procedure’, will provide the TIME applications associated with the process. It will also give you the steps needed to complete the process. The second section, ‘Menu(s)’, provides either the link to the CMS website or the path to the TIME application used within this step. The third section, ‘Purpose’, provides the objective (s) for the procedure outlined in the ‘Application & Procedure’ section of the Roadmap.

Changes to existing applications

Diagnosis Code Table TIME will still use the existing Diagnosis Code Table to support ICD-10 codes – A new subtab has been added for ICD-10 codes – A new field in the main browser has been added for ICD-10 codes.

Diagnosis Code Table Updates

ICD 10 Tab

Lookups where diagnosis codes are used

Insurance Codes

Claim Data and Service Trx – Service Tab

Claim Data and Service Trx – Claim Tab

Claim Data and Service Trx – Claim Diagnosis Maintenance

Claim Data and Service Trx – Additional Info Tab

Claim Data and Service Trx – Additional Info Tab – Claim Reason For Visit Diagnosis Maintenance

Claim Data and Service Trx – Additional Info Tab – Claim External Cause of Injury Diagnosis Maintenance

Service Charting

Medication Orders

Physician Rounding App and Encounter Home Page

Progress Note Template

Reports Hemodialysis Flowsheet Peritoneal Flowsheet Undone Labs and Meds Ordered Lab Patient Review Physician Rounding Medication Summary Adequacy/Bundled Payments – Detail Print DX Codes Monthly Services